Anatomical Position of Four Different Transobturator Mesh Implants for Female Anterior Prolapse Repair

Abstract

Purpose: Polypropylene mesh implants are frequently used for pelvic floor reconstruction in women. Yet they vary in size and fixation. The purpose of this study is to compare four mesh products with regard to their anatomical positioning and functionality within the pelvic floor, to determine whether each mesh fits equally well in a female cadaver. Methods: One female pelvis was dissected, opening the retropubic space exposing the endopelvic fascia and demonstrating the arcus tendineus fasciae pelvis (ATFP). Anatomical parameters were measured before and after implanting four meshes via the transobturator approach. Results: The anterior fixation of the ATFP was found to be 5 mm lateral to the symphysis in this cadaver. The endopelvic fascia covered 54.6 cm². The obturator nerve was located 35 mm from the white line. The distance of the proximal and lateral points of mesh fixation from the ischial spine or ATFP varied from 0 to 25 mm. The meshes varied in size and anatomical positioning. Conclusion: These observations demonstrate the necessity of developing optimally sized meshes and appropriate introducer techniques that can provide sufficient vaginal support. Surgeons, furthermore, need profound knowledge of anatomy, the patientʼs pelvic floor defect and the meshes available on the market.

Zusammenfassung

Vaginale Polypropylenimplantate werden zur Rekonstruktion des weiblichen Beckenbodens angewendet. Jedoch variieren die verschiedenen, auf dem Markt angebotenen Produkte in Form, Größe und Verankerungstechniken. Gegenstand dieser Studie ist es, 4 Produkte in eine weibliche Leiche zu implantieren, diese hinsichtlich der anatomischen Position und Funktionalität im Beckenboden zu untersuchen und festzustellen, ob die 4 Produkte in gleicher Weise in den Beckenboden dieser Leiche passen. Es wurde eine weibliche Frischleiche seziert. Die endopelvine Faszie wurde freigelegt und der Arcus tendineus fascia pelvis (ATFP) dargestellt. Vier auf dem Markt verfügbare transobturatorische Mesh-Implantate wurden nacheinander implantiert entsprechend der Herstellerangaben. Anatomische Parameter wurden vor und nach Mesh-Implantation festgehalten. Der anteriore Fixationspunkt des ATFP zeigte sich in dieser Leiche 5 mm lateral der Symphyse. Die endopelvine Faszie bedeckte einen Bereich von 54,6 cm². Der N. obturatorius wurde 35 mm entfernt vom ATFP dargestellt. Die Entfernung der proximalen und lateralen Fixationspunkte der Mesh-Implantate von der Spina ischiadica oder dem ATFP variierten von 0 bis 25 mm. Die Implantate unterscheiden sich in Größe und Lage zu anatomischen Strukturen. Zusammenfassend demonstrieren diese Ergebnisse die Notwendigkeit der Entwicklung von Implantaten optimaler Größe. Darüber hinaus benötigen die Anwender dieser Implantate detailliertes Wissen über die anatomischen Verhältnisse ihrer Patientin und auch der auf dem Markt erhältlichen Produkte, um ein zufriedenstellendes postoperatives Ergebnis zu ermöglichen.

Key words

mesh repair - arcus tendineus fasciae pelvis - white line - endopelvic fascia - pelvic floor anatomy

Schlüsselwörter

Mesh-Repair - Arcus tendineus fascia pelvis - White Line - endopelvine Faszie - Beckenbodenanatomie

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